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92_HB1954eng
HB1954 Engrossed LRB9200934ACcd
1 AN ACT to amend the Health Care Professional Credentials
2 Data Collection Act.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Health Care Professional Credentials Data
6 Collection Act is amended by changing Sections 15, 20, and 25
7 as follows:
8 (410 ILCS 517/15)
9 Sec. 15. Development and use of uniform health care and
10 hospital credentials forms.
11 (a) The Department, in consultation with the council,
12 shall by rule establish:
13 (1) a uniform health care credentials form that
14 shall include the credentials data commonly requested by
15 health care entities and health care plans for purposes
16 of credentialing and shall minimize the need for the
17 collection of additional credentials data;
18 (2) a uniform health care recredentials form that
19 shall include the credentials data commonly requested by
20 health care entities and health care plans for purposes
21 of recredentialing and shall minimize the need for the
22 collection of additional credentials data;
23 (3) a uniform hospital credentials form that shall
24 include the credentials data commonly requested by
25 hospitals for purposes of credentialing and shall
26 minimize the need for the collection of additional
27 credentials data;
28 (4) a uniform hospital recredentials form that
29 shall include the credentials data commonly requested by
30 hospitals for purposes of recredentialing and shall
31 minimize the need for collection of additional
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1 credentials data; and
2 (5) uniform updating forms.
3 (b) The uniform forms established in subsection (a)
4 shall be coordinated to reduce the need to provide redundant
5 information. Further, the forms shall be made available in
6 both paper and electronic formats.
7 (c) The Department, in consultation with the council,
8 shall establish by rule a date after which an electronic
9 format may be required by a health care entity, a health care
10 plan, or a hospital, and a health care professional may
11 require acceptance of an electronic format by a health care
12 entity, a health care plan, or a hospital.
13 (d) Beginning January July 1, 2002 2000, each health
14 care entity or health care plan that employs, contracts with,
15 or allows health care professionals to provide medical or
16 health care services and requires health care professionals
17 to be credentialed or recredentialed shall for purposes of
18 collecting credentials data only require:
19 (1) the uniform health care credentials form;
20 (2) the uniform health care recredentials form;
21 (3) the uniform updating forms; and
22 (4) any additional credentials data requested.
23 (e) Beginning January July 1, 2002 2000, each hospital
24 that employs, contracts with, or allows health care
25 professionals to provide medical or health care services and
26 requires health care professionals to be credentialed or
27 recredentialed shall for purposes of collecting credentials
28 data only require:
29 (1) the uniform hospital credentials form;
30 (2) the uniform hospital recredentials form;
31 (3) the uniform updating forms; and
32 (4) any additional credentials data requested.
33 (f) Each health care entity and health care plan shall
34 complete the process of verifying a health care
HB1954 Engrossed -3- LRB9200934ACcd
1 professional's credentials data in a timely fashion and shall
2 complete the process of credentialing or recredentialing of
3 the health care professional within 60 days after submission
4 of all credentials data and completion of verification of the
5 credentials data.
6 (g) Each health care professional shall provide any
7 corrections, updates, and modifications to his or her
8 credentials data to ensure that all credentials data on the
9 health care professional remains current. Such corrections,
10 updates, and modifications shall be provided within 5
11 business days for State health care professional license
12 revocation, federal Drug Enforcement Agency license
13 revocation, Medicare or Medicaid sanctions, revocation of
14 hospital privileges, any lapse in professional liability
15 coverage required by a health care entity, health care plan,
16 or hospital, or conviction of a felony, and within 45 days
17 for any other change in the information from the date the
18 health care professional knew of the change. All updates
19 shall be made on the uniform updating forms developed by the
20 Department.
21 (h) Any credentials data collected or obtained by the
22 health care entity, health care plan, or hospital shall be
23 confidential, as provided by law, and otherwise may not be
24 redisclosed without written consent of the health care
25 professional, except that in any proceeding to challenge
26 credentialing or recredentialing, or in any judicial review,
27 the claim of confidentiality shall not be invoked to deny a
28 health care professional, health care entity, health care
29 plan, or hospital access to or use of credentials data.
30 Nothing in this Section prevents a health care entity, health
31 care plan, or hospital from disclosing any credentials data
32 to its officers, directors, employees, agents,
33 subcontractors, medical staff members, any committee of the
34 health care entity, health care plan, or hospital involved in
HB1954 Engrossed -4- LRB9200934ACcd
1 the credentialing process, or accreditation bodies or
2 licensing agencies. However, any redisclosure of credentials
3 data contrary to this Section is prohibited.
4 (i) Nothing in this Act shall be construed to restrict
5 the right of any health care entity, health care plan or
6 hospital to request additional information necessary for
7 credentialing or recredentialing.
8 (j) Nothing in this Act shall be construed to restrict
9 in any way the authority of any health care entity, health
10 care plan or hospital to approve, suspend or deny an
11 application for hospital staff membership, clinical
12 privileges, or managed care network participation.
13 (k) Nothing in this Act shall be construed to prohibit
14 delegation of credentialing and recredentialing activities as
15 long as the delegated entity follows the requirements set
16 forth in this Act.
17 (l) Nothing in this Act shall be construed to require
18 any health care entity or health care plan to credential or
19 survey any health care professional.
20 (Source: P.A. 91-602, eff. 8-16-99.)
21 (410 ILCS 517/20)
22 Sec. 20. Single credentialing cycle.
23 (a) The Department, in consultation with the council,
24 shall by rule establish a single credentialing cycle. The
25 single credentialing cycle shall be based on a specific
26 variable or variables. To the extent possible the single
27 credentialing cycle shall be established to ensure that the
28 credentials data of all health care professionals in a group
29 or at a single site are collected during the same time
30 period. However, nothing in this Act shall be construed to
31 require the single credentialing cycle to be established to
32 ensure that the credentials data of all health care
33 professionals in a group or at a single site are collected
HB1954 Engrossed -5- LRB9200934ACcd
1 during the same time period.
2 (b) Beginning July 1, 2002 January 1, 2001, all health
3 care entities and health care plans shall obtain credentials
4 data on all health care professionals according to the
5 established single credentialing cycle.
6 (c) The Department, in consultation with the council,
7 shall by rule establish a process to exempt a small or unique
8 health care entity or small or unique health care plan from
9 the single credentialing cycle if the health care entity or
10 health care plan demonstrates to the Department that
11 adherence to the single credentialing cycle would be an undue
12 hardship for the health care entity or health care plan.
13 (d) The requirements of this Section shall not apply
14 when a health care professional submits initial credentials
15 data to a health care entity or health care plan outside of
16 the established single credentialing cycle, when a health
17 care professional's credentials data change substantively, or
18 when a health care entity or health care plan requires
19 recredentialing as a result of patient or quality assurance
20 issues.
21 (Source: P.A. 91-602, eff. 8-16-99.)
22 (410 ILCS 517/25)
23 Sec. 25. Single site survey.
24 (a) The Department, in consultation with the council,
25 shall by rule establish a uniform site survey instrument
26 taking into account national accreditation standards and
27 State requirements. The uniform site survey instrument shall
28 include all the site survey data requested by health care
29 entities and health care plans.
30 (b) No later than July 1, 2002 January 1, 2001, the
31 Department, in consultation with the council, shall publish,
32 in rule, the variable or variables for completing the single
33 site survey. To the extent possible, the single site survey
HB1954 Engrossed -6- LRB9200934ACcd
1 shall be established to ensure that all health care
2 professionals in a group or at a site are reviewed during the
3 same time period.
4 (c) Beginning January 1, 2003 July 1, 2001, health care
5 entities and health care plans shall implement the single
6 site survey, if a site survey is required by any of the
7 health care professional's health care entities or health
8 care plans. The site survey shall be completed using the
9 uniform site survey instrument.
10 (d) The uniform site survey instrument shall be used
11 when a health care professional seeks initial credentialing
12 by a health care entity or health care plan, when a health
13 care professional's credentials data change substantively, or
14 when a health care plan or health care entity requires a site
15 survey as a result of patient or quality assurance issues, if
16 a site survey is required by the health care entity or health
17 care plan.
18 (e) Nothing in this Section prohibits health care
19 entities and health care plans from choosing the independent
20 party to conduct the single site survey.
21 (Source: P.A. 91-602, eff. 8-16-99.)
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